Author: Spirited Idealist

Educator & Author

The news about ending the DACA program has gotten a lot of attention as it very well should. From a practical standpoint, if a child comes here at the age of one, lives here almost their entire life, and is suddenly deported to a country she never knew to begin with at the age of 23, how does that benefit Americans? Among other things, that young person is usually working, or about to start working, and that means paying taxes. DACA recipients work and pay taxes. Opponents of immigration reform are arguing hard and fast, attempting to strike fear into Americans by luridly suggesting that if we don’t deport these young people, that our families might become victims of crime—leaving off that these young people aren’t eligible for DACA if they’ve committed a serious crime, which they are less likely to do than the average American anyways. What is really going to occur is that American businesses are going to lose a great deal of money should these, often well-educated, young people be deported.

From a practical standpoint, it doesn’t make any sense, at all.

It’s telling that the people who are advocating to keep DACA are, for the most part, the people who work alongside DACA recipients, or hire them. Experience with DACA residents leads to a greater understanding of what it means to be a DACA recipient and what it’s like to work alongside one—those experiences are worth far more than any talking points on the matter. Experience matters.

So, why does the right want to remove DACA and export undocumented workers?

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TL;DR The average OECD country pays less than 4K per person on all healthcare expenses. Our taxes pay 6K per person right now in the US. We pay 3-4K more (OECD average) out of pocket. We are in the bottom 20% for care. If that isn’t outrageous enough, now the GOP is asking for 13K Maximim Out of Pocket (MOOP) for insurance companies. Why aren’t the pitchforks out?

While there are people on the right, such as Tara O’Neill Hayes arguing that that number is inaccurate, I have as yet to see one of these people consider how having pre-existing conditions would have otherwise prohibited these newly enrolled constituents from obtaining the policies they now have. The GOP’s BRCA options have all opened up pre-existing conditions as a new way for insurers to gouge their enrollees. Even when O’Neill Hayes argues that some young people covered until the age of 26 by their parents’ plans would have obtained insurance at their new places of employment, unless the new employer is offering equivalent, or better, coverage that they’ve rejected, the likelihood is those young people stay on their parents’ policies because they provide better coverages, and they are still benefitting from the policy options available to them as the result of the ACA policies.

Considering the fact that Americans pay more than nearly every other country on earth for healthcare, you’d think we would be getting the highest quality of care available, or close to it. Amazingly, nothing could be further from the truth, “The US ranks 28th, below almost all other rich countries [28 of 35], when it comes to the quality of its healthcare assessed by UN parameters.” We are in the bottom 20% of all industrialized nations for quality of care while paying more than everyone else. We come dead last in the top 11 wealthiest countries.

Here’s another way to look at the aggregate data:

In 2015, the most current year for accurate data on costs per person, the United States spent $9,507 per person for healthcare, the total of all public and private money spent. Something that may come as a complete shock to most Americans is that our government is already paying close to 2/3 of that cost, and is on track to increase to “67.1% in 2024.”

How many people realize that even without a national healthcare system, our taxes are already paying about 2/3 of the total amount spent on medical coverage in the United States?

If we take those numbers and estimate using 2015 data, the US government is spending approximately $6,338 per every man, woman, and child in the United states right now, today.

Now, that may not seem like a lot. That means we all should be paying around an additional $3,000 per person per year for our care, right?

Well…not so fast. If you consider that the United States spends “more than twice the average of other developed countries,” and our quality of care is in the bottom 20% of countries in the developed world, we have to recognize that we have serious and costly flaws in our current healthcare system. Looking at 2015 data again, the average cost per person for healthcare in all OECD countries works out to $3,727.

Think about this—what this means is that while we are in the bottom 20% for care, we are paying the most for it, which is $5,780 per person more than everyone else on average. Not only this, the money we pay in taxes is already $2,053 more per person than the average OECD country, where healthcare costs are covered 100% at that point—and we wind up owing so much afterwards on an individual basis that 26% of Americans state they are in trouble financially due to the costs of their medical care as documented in a prior post.

Our medical system is a fiscal disaster.

What is the GOP’s answer? Give us policies with $13,000 per person deductibles—more than quadruple what the average OECD country pays total per person so that they get a much higher quality of consistent, deductible free care!

The reality is the GOP is not fixing our healthcare system. Instead, all they are doing is creating policy designed to fleece the American public rather than doing what all Americans want—rework our healthcare policy so that it provides the quality of care that we pay for and no longer empties our wallets and leaves us struggling to pay our medical bills at the end of the day.

Our legislators have stopped listening to the needs of their constituents and have forgotten why they are in office. In response to the unprecedented rage expressed by voters shortly after the election, the GOP Senate Majority, Mitch McConnell, loftily proclaimed, “Winners make policy, losers go home.”

Every citizen in America should right now be calling their Senators, McConnell’s phone lines, and the White House to let them know that fleecing the American public as a form of healthcare policy is unacceptable under any circumstance and that if they are going to make healthcare policy, it had better be policy that delivers in regards to reduced waste, removing the insurance middlemen, and reducing our costs, or they should keep their money grubbing fingers away from our healthcare.

As we move forward, do not assume we are safe from the Republicans mangling the system we fought so hard to build 8 years ago. McConnell and Trump are only getting more desperate with each failed attempt to deliver an alternative, and rather than responding to their failed policy attempts by making better policy, they only have delivered less satisfactory options over time.

Keep calling, keep writing, and keep these GOP leaders under a microscope until we vote them out, as they are now desperate and only likely to engage in desperate measures at this late stage in the game.

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Being able to obtain quality, timely, affordable healthcare is what responsible and effective nations ensure for all of their citizens. The right likes to level accusations of “entitlement” when the subject of single-payer, or government sponsored healthcare arises. It’s not a matter of entitlement. It’s time for the left to reframe this discussion the way it should have been framed from the beginning and fight for a healthy future for all Americans.

Passing single-payer reforms is a matter of taking responsibility for future health needs of everyday Americans and our aging population. Doing anything less is simply negligent, considering our rankings on national health scores and the outrageous overhead of our past system, our current system, and the Republican proposed alternatives.

Say what? At this point, this argument should be seen as the façade that it truly is. With US medical administration costs 2 ½ x those of other OECD countries, the real question everyone should be asking themselves is how can we NOT afford single payer? Our current path, which was already problematic well before the ACA was enacted, as established before, is becoming untenable.

The insurance companies have had no interest in restraining medical costs, because they make more money the more we spend. Dr. Gary Sobelson says that insurance companies “make their profitability based on how much they collect in revenue.” Because of this, keeping the insurance industry as part of our primary medical coverage system has put us at a distinct cost disadvantage. If we want to keep them involved, they should only be involved in the limited role of providing add on services for those who are willing to pay additional money for care above and beyond the basics. Doing so makes sure that they are providing measurable value for the payments they collect, rather than taking advantage of those whose basic needs are at stake, which is the situation we currently have.

Woolhandler and Himmelstein wrote another paper, Liberal Benefits, Conservative Spending, where they argue, “National health insurance could solve the cost versus access conflict by slashing bureaucratic waste and reorienting the way we pay for health care,” and explain how the elimination of a very bureaucratic system in favor of bundled payments works to reduce overall healthcare costs. In the conservative argument for single-payer care, it is argued that because bureaucracy would be reduced and care would be emphasized, firms (and employees, of course) would be “spared the outrageous annual cost increases that have become commonplace in the large- and small-group markets.”

How Could Single-Payer Be Successfully Funded?

California right now is at the front of the single-payer debate. Michael Lighty, to begin with, the Director of Public Policy for National Nurses United and for the California Nurses Association, argues that “Californians will receive every federal healthcare dollar for which we are eligible, the question is in what form.”

In another piece, Lighty argues that, “Currently, 70 percent of healthcare expenses in California are paid by taxpayers.” Wait…say what? Taxpayers are already paying 70 percent of healthcare expenses in California? The vast majority of what is needed to pay for healthcare is already being covered by taxes already? He goes on to say that, “We estimated $37 billion can be saved by going to this Medicare-for-all-type system in California.”

In addition to these funds, some additional ways to secure the funding include a 15% payroll tax. According to Gerald Friedman, a University of Massachusetts economist, who has done the math, the original estimates make no mention of the savings that would be employed by switching to a single payer system, which he says is disappointing “because it assumes no savings from bulk purchasing of drugs and medical devices even though the rest of the world buys these at barely 70 percent what Americans pay, and the VA [Veterans Administration] buys drugs at 59 percent.” Based on what Californians are already paying right now for their medical, at a 15% payroll tax, many would find a significant costs savings, and they will find that “paying 15 percent of one’s income for health care is a very good deal.”

If California can successfully deliver on single-payer, it should give the rest of the nation the clear example it needs to get the job done.

The Real Question

The question shouldn’t be “How will we fund it?” Obviously, the details will have to be hammered out, but it is not the quagmire political opponents paint it to be. The real question is, “How do legislators find the political will to do what probably should have been done at least two decades ago?” Speaker Anthony Rendon has been standing between Californian’s and the single-payer system they want, and it’s pretty clear why, because “the healthcare industry has given the speaker, along with the insurance industry, over $700,000, and he’s the one who stopped progress on this bill.” When the process began in the Assembly, he “…decided to abort the process at the beginning of Assembly consideration of SB 562.” His action resulted in a “denial of democracy and is inconsistent with his claim that the bill needs work, because precisely the process that would have constituted that work was the one that he stopped.”

This question of where legislators find the political will actually has a ready-made answer. Not only that, since the election, and since the GOP has been threatening the ACA, people want to step up to the plate and act, so the time for us to act on this couldn’t be better.

Here’s what has to happen. Sacramento needs to hear us loud and clear, because, even though a lot of lobbyist money is standing between us and what we want, according to the University of Wisconsin Population Health Institute, “Decision makers find the political will to act when they feel the public’s demand for action. Your job is to make them feel that demand.” It’s as simple as that.

Californians need to make it crystal clear to lawmakers that we will stand for nothing less than a viable single-payer system for all California residents.

Speaker Rendon needs to hear from Californians and their own representatives who are invested in a healthier California for all so he realizes that it’s no longer politically expedient to stand in the way of what is best for California.

Ways to Get Involved

There are a few main organizations that can help you get involved in pushing for single-payer in the State of California right now.

Both of the following pages offer links for events to RSVP for, and participate in:

If you would like to see additional ways to get involved added to this list, please use the contact form on this site.

Conclusion

The reality is that single-payer is the responsible path towards a healthier future for all Americans. We already clearly pay a sizable amount of the money required to provide care to California’s population, and the remaining money needed to cover Californian’s completely should not be hard to carve out, as Californians already spend a fair amount in premiums and out of pocket every year. As the largest state economy in the nation, pushing single payer healthcare reform gives us the opportunity to set the standard for the rest of the country.

The only thing standing between us and a single-payer system is a matter of political will, and that is something every single Californian has the power to do something about. There are organizations who have already been active in working towards this shift and all we need to do is participate in the process by attending events supporting single-payer, contacting our state representatives, contacting the Speaker and Governor Brown, and asking the organizations above if there are any additional ways we can help move this policy change forward. All we really have to do is act, and act today.

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Reading the prior post on what works in healthcare can help people understand that many of the arguments against single-payer healthcare and government bureacracy are refutable, and why.

What the post doesn’t do is give you quick talking points. Today’s post is just that.

Here are a few simple things to focus on when someone says government care is “too expensive,” and will be “too wasteful,” and argue that care will cost even more:

1) Many providers with many plans and with many details requiring compliance increase ADMINISTRATION costs to 2 1/2x the average OECD country’s healthcare system. 2 1/2x! OUR bureaucracy is the one to worry about…not a government healthcare bureaucracy.

2) A tested and proven way to reduce costs are bundled payments which push providers to emphasize health over procedures (documenting each procedure for compensation costs a lot of money).

3) By putting all providers on the same reporting & documentation system, we will save a lot more money on administration, because it’s easier and time efficient. Also, while building that architecture, it would be easy to put patient care in OUR hands, because that same system could be built to put us in control of our own health records along with personalized details tailored to our own unique health needs that could be automatically generated based on doctor recommendations.

If you missed it and need more details, take a look at the in-depth, thoroughly documented piece on how I arrived at these conclusions in the previous blog post.

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Talking about what is wrong with our system is not going to fixour health care problems, just as anti-Obamacare rhetoric hasn’t solved the GOPs problems. We must offer, and promote, real world solutions to the problems we are having if anything is to improve.

How do we make it better? We have to learn what works and advocate for it, accepting nothing less. We’ve got momentum. We’ve got participation. Now we need to forge a path ahead that is different and is based in real solutions to the very real problems that are currently dragging our country in a downward spiral.

So, Who is Healthy and What Are They Doing?

First, it makes sense to see what works by determining which countries are the healthiest in the world, and then determine what they are getting right. Cultural and resource differences between countries can vary, but looking at what each system has in common can yield sensible ideas for reforms citizen activists can, and should be, advocating for. The information must be current, meet established standards for data collection, and the information analyzed in a way that cannot easily be construed as biased. The Most (and Least) Healthy Countries in the World meets these criteria for credible work, basing their analysis on World Bank data. They were also helpful enough to share their methodology with anyone who cares to review it, and are a source used widely for quality content in other publications.

Hopefully, the first thing Americans notice is that we are not on this list. Hello! We are not on this list! We pay an exorbitant amount of money as a country for medical care, and we aren’t even near the top of it. Depending on your source, we either spend the most, or a very close second to the most, per person on health care, and yet, we are behind dozens of other countries on health. Clearly, money isn’t the problem, which, in a way, is good news, because we spend enough to get better outcomes. How we are spending it is the only way to explain why we aren’t doing better.

You can see on this table that the data clearly indicates we are spending the most, or nearly the most, on healthcare. According to the OECD report, Why is Health Spending in the United States So High? “The United States spends two-and-a-half times more than the OECD average health expenditure per person.” While wealthy countries tend to spend more than poor countries, the United States is an outlier, with our population spending $3000 more per person than even the Swiss who enjoy the same income levels. That is approximately 50% more PER PERSON with far less healthy results. Where is all this money going? Our problem is caused by excessive administrative fees, how out dollars are allocated, and the way we access care.

Back to the table, nearly all of the countries that are most successful have some form of universal coverage. Some also include an option for private insurance for people who want greater access to services, or more individualized care. Even then, there is not one OECD country in the top 10 that spends significantly more money than Americans do. Universal care with a private option for additional services can be very effective in obtaining both healthy outcomes and additional services when needed.

How can we solve this problem?

The Organisation for Economic Co-operation and Development (OECD) provides support to countries wanting to improve health care policy. They help determine where to focus public money, advise countries how to structure medical payments for better healthcare outcomes, and help countries cut back on waste while promoting appropriate care. They work with countries, helping them adapt to new challenges and advances in healthcare and medications in addition to making sure adequate professionals are evenly distributed throughout populations. Finally, with our aging populations, they support countries making changes to adapt to the growing demand to serve them. According to the OECD, in addition to the many problems covered in my previous post, there are substantial inequalities in access to care in the United States (p. 24). Poor access to care undermines outcomes. We should be working alongside the OECD to improve our system using methods already proven successful in other countries where they make sense.

There is one thing that stands out that we are doing well at. The OECD report states that we actually do “very well in providing acute care for people admitted to hospital for life-threatening conditions.” Even though we are better at providing acute care, we spend LESS than Switzerland, Canada, Germany, France, and Japan on hospital care (chart 4 p. 3). Obviously, the efforts we have put into reducing hospital stays and reducing invasive surgeries has helped us spend considerably less on hospital care. This is one thing we are doing right.

On the other hand, when it comes to “regular monitoring and surveillance, involving patients in self-care, and providing them with counselling about dietary habits and the importance of regular physical exercise,” we have much more difficulty.

Consider Rebekah.* She went to her physician for a regular checkup. Having gained weight, she thought it was because of extraordinary personal stress she had been under. Her blood tests, on the other hand, showed she had elevated blood sugar levels. The doctor recommended medication or dietary changes and additional exercise. She made the dietary changes and increased her exercise, and within 3 months, she lost weight and her blood sugar levels had normalized. Had she avoided a visit to her clinic due to the cost of co-pays and blood tests, this could have gone undetected for quite some time.

Ongoing support in the form of routine medical care gives patients vital feedback and helps them reduce risk factors, leading to better overall health. Without it, far too many Americans are not getting the kind of personalized feedback that helps people make decisions that lead to healthier outcomes.

Spending

The OECD health spending per capita by category of care, chart 4 (p. 3), shows that Americans spend considerably more in each of the four categories of health spending when compared against Switzerland, Canada, Germany, France, and Japan, but Chart 4 also shows us that we spend tremendously more on ambulatory care, more than some of the top ten countries do on their entire health care expenditures. The Harvard Business School published a paper (p.24) saying, “The United States is a prime example of the ill effects of a large uninsured population without access to primary and preventive care, the prevalence of late and expensive acute treatment, and the distortive effect of cross-subsidies to care for the uninsured.” We are spending lots of money. We just do it ineffectively.

Probably unsurprising to many, Americans dospend far more on pharmaceuticals and medical goods than do these other countries.

Startlingly, however, is that we spend considerably more on public health and administration, “more than two-and-a-half times the average.” After years of telling taxpayers that putting the government in charge will cost more because of bureaucratic waste, is it a surprise to learn we are the ones paying more? Because of our many insurers, plans, and a lack of consistency between them, our costs far exceed the government run programs in every other nation on earth!

The reality is that we need a better system, and if we are going to have a better healthcare system, charging sick people more as the GOP is proposing will not put us on a better path. Their proposals have very little to offer in regards to to reducing actual costs, which should be more than feasible based on how we are currently allocating our healthcare dollars, nor do they do anything to improve American health.

Solutions

The following is a list of recommendations for our legislators to focus on in order to provide a better system, and better care for all Americans, to ensure a healthier future.

We should introduce methods of keeping costs lower and healthy outcomes higher by reducing waste and the inconsistencies in medical insurance providers, while also incentivizing providers to provide better care, helping consumers spend less overall. We spend more for almost every medical intervention than anyone else in the world on like-for-like medical care and receive fewer health benefits from it. Structuring payments to provide incentives for healthy outcomes and reduced costs has been shown to improve outcomes while simultaneously improving health.

We need a unified system of care.Harvey Jay Cohen, director of the Center for the Study of Aging and Human Development at Duke University Medical Center envisions “a system where all levels of care are linked.” Susan Love, in the same article, agrees, and advocates for a “team approach” to care. One of the biggest problems in our current healthcare system for people who have, and use, coverage are the gaps in care, gaps in coverage, gaps in available specialists, and gaps in the transfer of information from one caregiver to another, much of which is hard for patients to monitor due to the complexity of medical practice and even, in some cases, the ill health of patients, themselves. A nationalized or even state-wide systems of communication and collaboration among caregivers could help patients be better informed and obtain better care, reducing the stress and administrative burdens on medical staff.

This collaborative approach is not just smart financially. According to the The Commonwealth Fund, costs for chronically ill patients skyrocket “when the care they receive is poorly coordinated.” In poor transitions, “patients may undergo the same lab tests multiple times, they may get the wrong combination of medications, and serious conditions may get misdiagnosed.” This poor coordination means the quality of care goes down, “for the patients who most need help.” In addition to coordinating internally, hospital re-admissions could be reduced if a patient’s care team works with community services, nursing homes, and rehab facilities in a seamless manner, making sure patients and caregivers have clear instructions for self-care and follow up appointments.

We need transparency.When Elizabeth Agnvall interviewed 11 physicians asking them for one thing they would do to improve our healthcare system, three pointed out transparency as being critical to making healthier choices. Patients should be in charge of their own medical records, information regarding their health status, the expected outcomes for care, risks, and the costs associated with care, so they can make more informed decisions about activities and behaviors that are impacting their well-being.

Bundled payments & global payments are lump sum payments that go to a physician, care team, or healthcare organization “to treat a particular illness, condition, or injury,” incentivizing medical professionals to focus on healthy outcomes rather than procedures and procedural payments. Not only does this change the focus of care, it cuts down on administration considerably. Medical teams are then enlisted to help save money while achieving healthy outcomes, not to complete paperwork, and can earn incentives for doing it well.

We need to separate our employment from our medical coverage; with our employer sponsored health coverage, the United States is an oddity among industrialized nations. No other country in the industrialized world does this. We are the only ones in this boat, and it’s harmful to our overall financial well-being when we change jobs, can trap people in a jobs that are ill suited to them, or cause an employer to under employ workers simply to save money and avoid paying for mandatory benefits. According to Uwe E. Reinhardt in his article titled, The Illogic of Employer-Sponsored Health Insurance, “Citizens in any other industrialized country have permanent, portable insurance not tied to a particular job in a particular country.” In our increasingly transitory employment market, we need to uncouple our healthcare from our place of employment for the sake of both our personal bottom lines and for our overall health and well-being.

We probably need a single-payer system as part of the solution to our problems. The vast majority of first world countries have them (map), and they definitely can help support a coordinated system of care, relieving the excessive administrative requirements healthcare providers have to follow in order to comply with our overabundance of providers and policies. This also eliminates the confusing gaps in our medical care that patients deal with routinely. An organization that has been actively advocating for a single-payer along with various improvements to our current medical system is the Physicians for a National Health Program. They’ve been working hard to coordinate change, and support improvements to the current system such as the Medicare for All Act, H.R. 676.

Conclusion

The Senate has been working behind closed doors on legislative changes to our healthcare system, fighting transparency and avoiding public input. McConnell has even gone so far to tell people who disagree with him on policies that, “Winners make policy, losers go home.” Trump’s latest nefarious tweets are publicly urging them to repeal the ACA without a replacement, leaving millions of Americans’ health care and financial well-being at-risk.

If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!

It’s time to answer the GOP’s clarion call for help. Single-payer reforms work around the world, and better. The costs shown here, recommendations for reducing the exorbitant costs of healthcare in this country, and a list of solutions that could solve a host of problems that patients experience in our healthcare system every day due to the lack of consistency, transparency, and collaboration of care. Government involvement should not increase costs, and this data needs to be used to drive the decisions being made right now in the Senate.

Everyone needs to communicate with their senators, and in California, communicating with their local representatives and the governor. We have to tell our government representatives what we expect them to do, and use the energy that was harnessed by the election of this unpopular president to push for better healthcareat a better price for all of us.

With the frenetic pace of activity in Washington D.C. and Sacramento, and leaks coming out of D.C., it’s imperative to contact our representatives right away, and let them know exactly what we think about the work they are doing, that failure is not an option, and we need to make sure they know what solutions we want them to provide.

*pseudonym

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So, the next piece I’m working on is an analysis of what actually works in the 10 healthiest countries in the world, and will be considering any specifically American needs that may be related to those factors.

We all know that the democrats actually sold the American people out on a few things to compromise with GOP to pass the ACA, failing to provide us with a single payer system, and putting big business above the needs of the Average American, to keep insurance companies as the middle men in what has been a rather gap filled, poor application of what people actually need.

Now that I’ve heard that the GOP is all out of ideas, perhaps my next post will be of assistance to them. Obviously, the GOP needs little ‘ol me to do their work for them. Well, okay, if you guys want to put it that way…

Be ready to pass it along, because they seem embattled, lost, and confused, and obviously have put out the clarion call for help!